Provider Demographics
NPI:1912229568
Name:COLE, CYNTHIA (LMT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-5030
Mailing Address - Country:US
Mailing Address - Phone:239-289-0676
Mailing Address - Fax:239-352-3048
Practice Address - Street 1:3811 AIRPORT PULLING RD N
Practice Address - Street 2:SUITE 202
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-2512
Practice Address - Country:US
Practice Address - Phone:239-289-0676
Practice Address - Fax:239-352-3048
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA55817225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist